| Renal transplant rejection
Astagraf XL vs Envarsus XR
Side-by-side clinical, coverage, and cost comparison for renal transplant rejection.Deep comparison between: Astagraf Xl vs Envarsus with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsEnvarsus has a higher rate of injection site reactions vs Astagraf Xl based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Envarsus but not Astagraf Xl, including UnitedHealthcare
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Category
Astagraf Xl
Envarsus
At A Glance
Oral
Daily
Calcineurin inhibitor
Oral
Once daily
Calcineurin inhibitor
Indications
- Renal transplant rejection
- Renal transplant rejection
Dosing
Renal transplant rejection - adult (with basiliximab induction) 0.15 to 0.2 mg/kg once daily prior to reperfusion or within 48 hours of completion of transplant, with MMF and steroids; taken orally every morning on an empty stomach.
Renal transplant rejection - adult (without basiliximab induction) Pre-operative: 0.1 mg/kg within 12 hours prior to reperfusion; post-operative: 0.2 mg/kg once daily at least 4 hours after pre-operative dose and within 12 hours after reperfusion, with MMF and steroids.
Renal transplant rejection - pediatric (with basiliximab induction) 0.3 mg/kg once daily administered within 24 hours following reperfusion, with MMF and steroids.
Renal transplant rejection (de novo, with antibody induction) 0.14 mg/kg/day orally once daily on an empty stomach; target trough 6-11 ng/mL in month 1, 4-11 ng/mL thereafter.
Renal transplant rejection (conversion from tacrolimus immediate-release) 80% of the pre-conversion total daily dose of tacrolimus immediate-release orally once daily; titrate to target trough 4-11 ng/mL.
Contraindications
- Known hypersensitivity to tacrolimus
- Known hypersensitivity to tacrolimus or to any ingredient in ENVARSUS XR
Adverse Reactions
Most common (>=30%) Diarrhea, constipation, nausea, peripheral edema, tremor, anemia
Serious Lymphoma and other malignancies, serious infections, new onset diabetes after transplant, nephrotoxicity, neurotoxicity, hyperkalemia, hypertension, QT prolongation, pure red cell aplasia, thrombotic microangiopathy including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura
Postmarketing Agranulocytosis, pancytopenia, cardiac arrest, myocardial infarction, Torsades de pointes, Stevens-Johnson syndrome, toxic epidermal necrolysis, progressive multifocal leukoencephalopathy, posterior reversible encephalopathy syndrome, hepatic failure, graft versus host disease
Most common (>=10%) diarrhea, anemia, urinary tract infection, hypertension, tremor, constipation, diabetes mellitus, peripheral edema, hyperkalemia, headache, hypophosphatemia, leukopenia, nausea, insomnia, increased blood creatinine, hypomagnesemia, hypokalemia, hyperglycemia
Serious lymphoma and other malignancies, serious infections, new onset diabetes after transplant, nephrotoxicity, neurotoxicity, hyperkalemia, hypertension, QT prolongation, pure red cell aplasia, thrombotic microangiopathy including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura
Postmarketing agranulocytosis, hemolytic anemia, hemolytic uremic syndrome, pancytopenia, pure red cell aplasia, thrombotic thrombocytopenic purpura, cardiac arrest, Torsades de pointes, hearing loss, blindness, gastrointestinal perforation, hepatic failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, lymphoma, progressive multifocal leukoencephalopathy, posterior reversible encephalopathy syndrome, acute renal failure, rhabdomyolysis
Pharmacology
Calcineurin inhibitor; tacrolimus binds the intracellular protein FKBP-12 to form a complex that inhibits calcineurin phosphatase activity, blocking dephosphorylation and translocation of NF-AT and NF-kB and thereby suppressing T-lymphocyte activation, proliferation, and T-helper-cell-dependent B-cell responses.
Tacrolimus is a calcineurin inhibitor that binds the intracellular protein FKBP-12, forming a complex that inhibits calcineurin phosphatase activity, thereby preventing T-lymphocyte activation and proliferation by blocking production of multiple cytokines including IL-2 and TNF-alpha.
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Most Common Insurance
Anthem BCBS
Astagraf Xl
- Covered on 5 commercial plans
- PA (4/12) · Step Therapy (0/12) · Qty limit (0/12)
Envarsus
- Covered on 5 commercial plans
- PA (6/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Astagraf Xl
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Envarsus
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Astagraf Xl
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (0/3) · Qty limit (0/3)
Envarsus
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: AutoImmune - Medicare Access
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Final cost depends on formulary coverage
No savings programs available for Envarsus.
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Astagraf XlView full Astagraf Xl profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.